Validation of the Ottawa knee rule in adults: A single centre study.
Knee injuries
clinical decision rules
radiography
Journal
Journal of medical radiation sciences
ISSN: 2051-3909
Titre abrégé: J Med Radiat Sci
Pays: United States
ID NLM: 101620352
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
16
01
2020
revised:
10
05
2020
accepted:
15
05
2020
pubmed:
23
6
2020
medline:
16
6
2021
entrez:
23
6
2020
Statut:
ppublish
Résumé
This clinical audit aimed to evaluate performance of the Ottawa Knee Rule (OKR) and degree of compliance by emergency referrers for acute knee injuries in adults. Knee radiography requests were analysed retrospectively for eligibility. Data were extracted from eligible requests under headings describing the OKR criteria, patient history, diagnosis and referrer profession. Sensitivity, specificity, negative likelihood ratio and positive likelihood ratio were calculated with 95% CI for the entire sample and each profession (consultant doctors, resident medical officers [RMO], physiotherapists and triage nurses) individually. The frequency of each OKR criterion and correlation with fracture, referrer compliance to the rule and the relative reduction in radiography were also calculated. Of 713 patients identified, 149 were enrolled by the eligibility criteria. The overall sensitivity, specificity, negative likelihood ratio and positive likelihood ratio of the OKR for knee fracture were 71% (95%CI, 49-87%), 46% (95%CI, 37-55%), 0.64 (95%CI, 0.33-1.22) and 1.3 (95%CI, 0.96-1.76), respectively. Physiotherapists and triage nurses demonstrated better rule performance than consultant doctors and RMOs, with a sensitivity of 100% and negative likelihood ratio of 0.0. Physiotherapists were most compliant at 73% (19/26). Only 85 requests were OKR positive and, when abiding by the rule, this would have reduced radiography by 43% (64/149). In this first Australian study, moderate OKR performance and variable compliance by emergency referrers were observed. This led to unnecessary irradiation of patients without a fracture. The findings suggest emergency referrers could benefit from education on applying and documenting the OKR on radiography requests.
Identifiants
pubmed: 32567156
doi: 10.1002/jmrs.411
pmc: PMC7476189
doi:
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
193-198Informations de copyright
© 2020 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.
Références
J Emerg Med. 1997 Jul-Aug;15(4):459-63
pubmed: 9279695
Eur Radiol. 2002 May;12(5):1218-20
pubmed: 11976870
J Emerg Med. 2003 Feb;24(2):147-50
pubmed: 12609643
Eur Radiol. 2020 Aug;30(8):4438-4446
pubmed: 32222797
Am J Emerg Med. 1994 Sep;12(5):541-3
pubmed: 8060409
Ann Emerg Med. 1995 Oct;26(4):405-13
pubmed: 7574120
Ann Intern Med. 2004 Jan 20;140(2):121-4
pubmed: 14734335
Ann Emerg Med. 1995 Oct;26(4):429-33
pubmed: 7574123
Ann Emerg Med. 2003 Jul;42(1):48-55
pubmed: 12827123
Eur J Emerg Med. 2004 Aug;11(4):204-7
pubmed: 15249806
JAMA. 1997 Dec 17;278(23):2075-9
pubmed: 9403421
JAMA. 1996 Feb 28;275(8):611-5
pubmed: 8594242
AJR Am J Roentgenol. 1999 Apr;172(4):1069-71
pubmed: 10587149
Ann Emerg Med. 2001 Oct;38(4):364-8
pubmed: 11574791
J Emerg Med. 1995 Sep-Oct;13(5):611-5
pubmed: 8530777
Acad Emerg Med. 2001 Feb;8(2):112-6
pubmed: 11157285
Emerg Med J. 2010 Nov;27(11):849-51
pubmed: 20378739
West J Emerg Med. 2012 Sep;13(4):366-72
pubmed: 23251717